Custom knee replacements Tech allows for improved patient mobility

CHRIS DORST | GazetteDr. Vivek Neginhal, of the Scott Orthopedic Center in Huntington, shows off a model knee created by the ConforMIS 3-D printer. The knees are created to replicate the natural knee of the patient and are based on scans and X-rays sent to the company.

ConforMIS knee replacements are created by a 3-D printer and designed to replicate a patient’s natural knee, minus any existing wear and tear.

Knee replacement patient Larry Workman shows the scar on his left knee from his custom knee replacement in May.

CHRIS DORST | Sunday Gazette-Mail photos
Dr. Vivek Nigenhal, of the Scott Orthopedic Center in Huntington, with patient Larry Workman, who underwent a custom knee replacement in May and is now walking normally.

HUNTINGTON — At last year’s Greenbrier Classic, Larry Workman spent most of the tournament at the same spot — the grandstands near the 18th hole of the Old White golf course.

His son is the superintendent of the Old White, and Workman, like his son, loves golf. A Huntington native and retired civil engineer, Workman now owns 300 acres in Louisa, Kentucky, where he operates a winery. But years of physical activity had left his left knee stiff and painful, and Workman, 70, started to find doing the things he loved difficult.

“This year, I feel very confident that I’ll be able to follow Bubba Watson around,” Workman said Wednesday, sitting in an exam room at the Scott Orthopedic Center in Huntington.

Workman is up and about this year, after a knee replacement performed by Dr. Vivek Neginhal, the director of St. Mary’s Regional Joint Replacement Center. More impressive is the speed of his recovery — Workman had his surgery May 6, and he said he’s walking normally and without pain less than two months later.

According to Dr. Neginhal, Workman’s post-operation success is markedly better than most “traditional” knee replacements. That’s because Workman’s new knee isn’t a traditional one, but a “custom knee” crafted by a 3-D printer and based on scans of Workman’s own knee.

“This is my specialty. I replace hips and knees for a living, producing great results, but we are trying to catch those who wish to be playing golf, doing everything — demanding patients,” Neginhal said. “I have contemporaries around the country who are letting their patients ski eight to 10 weeks post-surgery.”

The knee, created by ConforMIS, is different from traditional knee replacements, which are uniform and come in a range of sizes, or “custom fit” knees, which use off-the-shelf knee replacements, but use patient-specific “jigs,” or cutting guides, to perform the implant. “Custom fit” knees are now the most common in West Virginia, but according to Dr. Neginhal, when he implanted the first custom fit knee in the state in 2008, many doctors were still skeptical of its uses.

“The custom fit knee just made a surgeon’s life easier, but it does not change the way we do knees,” Neginhal said. “This is a shift in a paradigm. This changes the way we do knees, and it changes the way patients feel about their knees. People thought that the more sizes we had, the better able we would be to make patients happy, but size is only a part of the puzzle.”

According to Dr. Neginhal, performing traditional knee surgeries in the past often meant compromising when it came to determining the right size.

“There were four or five sizes to start with, and now there are maybe seven or eight, but how many millions of people are there who are not like each other? And it’s isn’t just the sizes; even the shapes are different,” he said. “I would say knees are almost as unique as a patient’s face.”

The procedure is covered by Medicare, and Dr. Neginhal said he has implanted 14 ConforMIS knees in the last two months. Workman was one of the first, and according to Dr. Neginhal, his improvement is like that of a patient more than six months after a traditional knee replacement.

“For 20 years, we’ve been putting a symmetrical, off-the-shelf knee in an asymmetrical joint. We’ve been putting a symmetrical design into a shape we know is asymmetrical. Essentially, what we’re doing is custom making that shape for every patient, and replicating that natural anatomy,” said Andrew Shrewsbury, the local representative for ConforMIS.

Dr. Neginhal said the goal for him isn’t to advocate for one surgery over another, and said that even a custom knee will likely not feel like a completely natural knee for most patients, but it has its own advantages: less cutting of the bone in the knee, less blood loss, and a faster recovery time.

“How many people in their right mind wouldn’t want the newest technology? I trusted my doctor,” Workman said. “It’s impossible to replicate God’s work, but this is probably as close as it can get.”